Welcome to Professional and Technical Services (PTS) – experts in chemical disinfection for infection prevention. Our goal is to educate and provide you the latest resources related to cleaning and disinfection of environmental surfaces, medical devices and hands. As specialists in disinfectant chemistries, microbiology, environmental cleaning and disinfection, facility assessments and policy and procedure creation we are dedicated to helping any person or facility who uses chemical disinfectants.

Thursday, June 27, 2013

Knowing that I am likely to be mocked by my colleagues
for using my son in yet another blog, I think those of you with children will
appreciate this analogy. Kids are
sieves. They soak up everything you say
and in particular EVERYTHING you don't want them to repeat. In our house, these are deemed
"Bathroom" words. Aside from
the obvious "bad" words, I did not realize the list of unobvious
words that have now become taboo in my vocabulary such as stupid, idiot, butt
or butthead, nerd or loser. I am really
running out of descriptive words to use when on the verge of road rage because
the IDIOT in front of me has braked for no apparent reason. Inevitably from the back seat I hear
"MOM - that's a BATHROOM word!"

From a manufacturer's perspective, EPA registration of
disinfectants is a long and windy road often filled with potholes, U-turns and
the occasional dead end. It's true,
there are defined test methods that a manufacturer must use to prove product
disinfectant efficacy, toxicity profiles and chemistry profiles etc. There are also a number of supporting
documents that the EPA has published such as the EPA Label Review Manual and
Code of Federal Regulations - Labeling Requirements to "help" ensure that disinfectant product labels,
marketing materials, advertisements, websites and even tradeshow booth graphics
use "approved" language and avoid the use of
"inappropriate" language.

Safe, Safely, Safer, Safest, Green, Non-Toxic,
Harmless... etc, etc are wonderfully simple yet descriptive words that clearly
impart in plain English a meaning that the general population can
understand. These words can easily be
found in the Merriam or Webster dictionary, however, in the EPA's Dictionary of
Approved Words that CAN be used on Disinfectant Product Labels or Marketing
Materials they do not exist. They are
banned, they are taboo, they are to be avoided at all costs and if
used....there can be hefty repercussions.

Unfortunately, from a consumer perspective there is no
class that can be taken to learn what can and cannot, should and should not be
included on disinfectant product labels or marketing materials. "Policing" of disinfectant
marketing materials, advertisement etc is primarily left to industry to monitor
their competitors. Most reputable
manufacturers follow the rules and ensure that they do not use words or phrases
that are considered false or misleading, however, there are those unscrupulous
companies that know the general consumer does not understand what can be said
by law on their marketing materials and also know that "simple" words
such as Safe or Harmless will resonate with the consumer looking to choose a
product. They have no qualms pulling the
wool over your eyes to sell more product or position their product against
similar competitive products to gain a competitive edge so to speak and make
another buck.

To become a "Pro" at reading and interpreting
disinfectant labels and marketing materials you certainly can use the EPA Label
Review Manual or CFR Labeling Requirements regulation, but having read them
myself, save yourself the trouble.
Instead when reviewing new disinfectant products ask yourself the
following:

1. Do these claims seem too good to be true? If they do, ask to see the data used to make
the claims.

2. Is the wool being pulled over my eyes? Do these claims
or statements seem misleading? If so,
investigate further and ask lots of questions and gather the data to support
the claims.

3. Are they using "Bathroom" words? If they are, you should question the accuracy
and appropriateness of such claims.

As a consumer if you are uncertain as to the
appropriateness of claims or statements made on disinfectant products and their
associated marketing materials you can submit an inquiry to the EPA or just
call or email me...I'd be happy to provide clarification for you!

Monday, June 24, 2013

Being a Clean Freak, I'm passionate about building the
science behind cleaning and disinfection.
The infection prevention guidelines we follow are built around
science-based evidence so I certainly agree that the more we study,
investigate, hypothesize, pontificate the more we will learn and improve upon
our current practices. However, we need
to understand the limitations of some of the methods we use to build the
science.

The use of ATP meters is certainly gaining popularity and
don't get me wrong, I think there is a place for their use, but in designing
studies to help further the science behind cleaning and disinfection we MUST
understand the limitations of some of the methods we are using. In October of last year, we posted a blog on
ATP (ATP – a microbiologist’s square peg) the impetus of which was based on the
realization that Environmental Service Managers and Infection Preventionists
believed that ATP can be used to compare cleaning and disinfection efficacy
between different disinfectants.

ATP can be used as an indicator to determine cleanliness
of a surface, however there are a number of limitations with its use:

1. The measurement of ATP is not standardized:

1. Each ATP meter
has different detection limits therefore a statistical analysis must be done to ensure that consistent results can
be achieved.

2. No ATP meter
is the same.

3. Each ATP meter
has its own minimum detection limit – if the contamination of a surface is below a certain level the ATP meter may
not be able to detect it. This means that a surface
can have significant contamination and have an ATP reading of zero!

2. Chemical interference from residual cleaners and
disinfectants has an effect on the ATP readings:

1. Disinfectant
and cleaning chemistries can either quench – causing false low readings as seen with bleach or enhance – causing
false high readings as seen with quats and anionic
surfactants (detergents).

2. There are two
possible explanations for quenching:

a. The disinfectant ingredients are breaking the ATP
molecules and thus they are no longer active/detectible;

b. The disinfectant ingredients enter into the enzymatic
reaction from the swab and interfere with the enzymatic pathways for
luminescence production.

3. The level of
quenching (providing false low readings) with sodium hypochlorite (bleach) increases as the concentration of bleach
increases.

4. These chemical
interferences can give misleading results that can have significant implications on interpretation of data.

3. There is conflicting evidence to support a correlation
between RLUs and the bacteria left on a surface (the amount of bacteria is
determined by Colony Forming Units or CFUs):

1. Some studies
show a correlation between RLUs and CFUs, other studies show a loose correlation while other studies have not
examined the correlation between the two.

I completely stand behind the fact that ATP can be used
to assess the effectiveness of a cleaning program but if used for quality
control measures the results should be cautiously interpreted and at least
periodically checked with plate counting methods. As illustrated in our study, depending on the
sensitivity of the ATP meter, even high levels of contamination on the surface
may not be detected. This can lead to a
false confidence in the cleaning program.
Most importantly, ATP CANNOT AND SHOULD NOT be used to compare cleaning or disinfection
effectiveness between difference chemistries.
Different chemistries have distinctive quenching or enhancing effects on
ATP readings making meaningful and accurate evaluations between cleaning/disinfectant
chemistries unreliable as the RLU
readings do not account for such differences.

If you're looking to change cleaning and disinfecting
products and are looking at the use of ATP to determine which product works
better I hope you'll think twice!

Friday, June 14, 2013

The 40th Annual APIC (Association for Professionals in
Infection Prevention and Epidemiology) Conference was held in Fort Lauderdale,
Florida this past weekend. One of the
privileges of my job is the ability to attend Infection Prevention conferences
around the globe, the downside of course being the travel - which to some may
seem glamorous and fun, but trust me, being on a plane landing as one of the
cells of Hurricane Andrea is hitting the coast of Florida is far from fun.

On second thought, I take that back, I LOVE roller
coasters and actually happen to love being on a plane when we hit
turbulence. The torrential rain I could
do without!

If you have never been APIC is an amazing conference that
offers a wide scope of educational tracks.
I think even a non-Infection Preventionist could find a session they
would be interested in! This year, the
opening ceremonies kicked off with a celebration of APIC's 40th anniversary by
looking back through the years to see how Infection Prevention has
evolved. Founded in 1972 (yet another
thing younger than me..) by a group of pioneering Infection Preventionists
(IP), the review of how infection control evolved through the '70's, '80's,
'90's and '00's was insightful and entertaining. In the 1970's, infection control was
controversial to the point that one IP was told "the only surveillance
you're going to do in the future is in the checkout lane at a grocery
store". Today, every healthcare
facility has a surveillance program in place with many countries around the
world having laws for mandatory reporting for hospital associated infections.

The 1980's saw the birth of what we now know as Routine or Standard Precautions. Originally
introduced as Body Substance Isolation or BSI.
Nurses did not wear gloves because of the psychosocial belief taught
during nursing school that gloves would make patients uncomfortable. BSI became the risk assessment tool used to
help limit exposure to body substances and limit the risk of contracting an
infectious disease through contact with body substances.

As society continued to develop and use "state of
the art" devices (think portable cell phones), so too did healthcare
facilities. With technological advancements, new ways of transmitting diseases
were brought to light. The 1990's
ushered in the era of device-associated outbreaks. One of the first published studies in a
medical journal included the review of an outbreak caused by a medical device
and the understanding that investigations need to also include where corners
are being cut whether it be by the device manufacture, the medical personnel
reprocessing the devices or the use of single-use devices.

With the arrival of the millennium and of course SARS,
infection prevention in the 2000's finally saw national awareness that HAI's
were preventable and UNACCEPTABLE. We
are now in an era where we are not just looking at evidence-based guidelines to
improve patient outcomes and prevent disease transmission, but focusing on
implementation science to ensure that the "evidence" can be put into
practice by healthcare workers for every patient. IPs are also now understanding that their
role is not only about stopping HAIs, but helping the C-suite to understand
that investing in infection prevention programs, can in fact save money for a
facility.

In the end, I was among 4000 delegates from around the
world and 295 vendors attending APIC not
just to learn, but to share our experiences to further infection
prevention.

Thursday, June 6, 2013

For many of our readers, today is likely your first day
back from the annual CHICA-Canada conference (Canada's National Infection
Prevention and Control Association).
The speaker line up and breadth of topics was impressive. Opening the conference was Dr. Martin Wale
from Vancouver, BC with in inspiring talk on "Thinking Differently About
IPAC: A More Strategic Approach".
The closing session was given by Sir Liam Donaldson from the United
Kingdom talking about "Global Patient Safety".

The Clean Freaks "gamified" Talk Clean To Me by
creating a "It's Time to Get Social" game. Each delegate was given a
Talk Clean To Me button with a unique number and challenged to talk to other
delegates through whatever means necessary to find their match (e.g. another
delegate who had the same number on their button). As the days progressed we had people during
question period following the seminars introducing themselves and their number,
we had presenters add their Talk Clean To Me number at the end of their
presentations, many tweeted using the #CHICACanada2013 hashtag and one delegate
used her Outbreak Management sleuthing skills to track down her match literally
by following up with "contacts".
She knew the facility the person was from and quite literally tracked
her down amongst the 500 plus delegates!

Alexis Silverman (Top Centre) found her match with me
winning the grand prize of an iPad Mini.
Shirley MacDonald and Camilla Levers (bottom left) and Nancy
Todd-Giordano and Barbara Catt (bottom right) found their matches and will
receive free registration to the Virox Cleaning, Disinfection and Sterilization
Symposium Pre-Conference Day at the 2014 CHICA-Canada conference in Halifax,
NS.

Thanks to everyone who played along with us! If you are in Fort Lauderdale this weekend
for the APIC Conference be sure to drop by our booth to get your Talk Clean To
Me mug and Webber Training Infection Control Posters!